Senior Manager Claims Cost Management

About the role

This role manages a comprehensive claim cost containment area for HealthPartners. The Claims Cost Senior Manager provides direct administrative support to Claims Department processes, new business initiatives, and participates in the development and implementation of key Administrative Systems projects and strategic operational initiatives. They work directly with all levels of staff within the organization, providing leadership for administrative functions.

Responsibilities

• Supervise staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees.
• Ensure compliance to organizational and departmental policies and procedures.
• Provide management leadership for designated administrative areas.
• Facilitate communication with business functional leaders regarding operational and functional area development, impact analysis of new business initiatives, regulatory matters.
• Direct the analysis of complex business operations, define requirements.
• Perform feasibility studies and produce cost/benefit information, complete requirement analysis.
• Ensure optimum benefit dollar recovery through third party liability provisions and claim refund activity.
• Develop recovery theory and investigate potential overpayments, assess potential for financial recovery.
• Identify recovery opportunities through detailed review of informational and data sources.
• Contribute to the development of operational processes within the team as well as policies and procedures.
• Identify critical issues needing resolution. Address changes and strategic projects if required.
• Provide leadership for affordability and customer-driven initiatives.
• Serve as an administrative expert, including for functional areas and issues related to Claims.
• Represent HealthPartners in dealings with external and internal audit firms and other outside organizations.
• Meet or exceed targets established for recoveries.

Requirements

• Bachelor's Degree
• 7-10 years of related experience within a regulatory and/or healthcare compliance environment preferred.
• Ability to search out and identify recovery and cost containment opportunities.
• Effective leadership, change management, and judgment skills.
• Excellent communication skills; verbal, written.
• Establish positive relationships internally and with industry groups and regulatory agencies.
• Solid business acumen and good understanding of business processes and dependencies.
• Healthcare data analysis experience.
• Strong customer focus and negotiation skills.
• Demonstrated skill in planning, organizing, and time management.
• Ability to analyze and interpret data and communicate action plans.

Preferred Qualifications

• Masters degree in business administration, or other health-related field.
• Decision-making ability.
• Staff recruitment, retention, and training.

Benefits

Designed to support your total health. Comprehensive benefits package includes health, time off, retirement planning, and continuous learning opportunities.